Because of the great importance of liver failure as a health problem in patients with hepatic cirrhosis and partial hypertension, continued investigation of the pre and post shunt hemodynamic changes associated with liver failure are studied. Suitable techniques to study portal vein hemodynamics have been developed in our institution, and because of the recent availability of newer techniques of portal venous reconstruction, we are continuing our hemodynamic investigation of patients in whom portal venous reconstruction is required because of upper gastrointestinal hemorrhage from gastroesophageal varices. Specifically, the effect of the distal splenorenal or mesocaval shunt on major hemodynamic parameters is being studied. The theoretical advantages of selective, distal splenorenal shunt are being realized in the preservation of prograde blood flow within the portal vein toward the liver. The maintenance of prograde blood flow following distal splenorenal shunt stands in contrast to the average retrograde portal vein blood flow after mesocaval shunt. Thus the hemodynamic sequelae of two of the most widely used techniques of portal venous reconstruction are being documented in patients undergoing elective portasystemic shunts. In addition, basic clinical data are being recorded which will enable us to study the correlation between changes in portal vein blood flow after shunt or the base line preoperative blood flow in a given patient, to the subsequent clinical course of the patient. Specifically the incidence of liver failure and/or encephalopathy will be studied. An additional period of time beyond the initial five years of funding will be definitely necessary in order to achieve the second, and the most important goals of this clinical study, namely, the correlation of pre and post shunt hemodynamics to the post shunt patient survival and morbidity (liver failure and encephalopathy).